Active NPI
Kevin Daniel Castleberry, DDS
- General Practice Dentistry
- Green Lake, WI
National Provider Identifier
1366857146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7284-15
- Practice address
- 560 Mill St
Green Lake, WI 54941 - Phone
- (920) 294-6790
- NPI assigned
- Jun 30, 2014
- Last updated
- May 16, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7284-15 | WI | Primary |
Addresses
Primary practice location
560 Mill St
Green Lake, WI 54941
Mailing address
560 Mill St
Green Lake, WI 54941-9527
Phone (920) 294-6790
Other practice location 1
Bldg 2441 21st Street
US Army Dental Activity
Fort Campbell, KY 42223
Phone (270) 798-8751
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7284-15 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526428800000",
"number": "1366857146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "560 MILL ST",
"city": "GREEN LAKE",
"state": "WI",
"postal_code": "549419527",
"telephone_number": "920-294-6790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 MILL ST",
"city": "GREEN LAKE",
"state": "WI",
"postal_code": "54941",
"telephone_number": "920-294-6790"
}
],
"practiceLocations": [
{
"address_1": "Bldg 2441 21st Street",
"address_2": "US Army Dental Activity",
"address_purpose": "LOCATION",
"city": "Fort Campbell",
"state": "KY",
"postal_code": "42223",
"country_code": "US",
"telephone_number": "270-798-8751",
"fax_number": "270-956-0266",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CASTLEBERRY",
"first_name": "KEVIN",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-30",
"last_updated": "2018-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "7284-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Lake, WI
- Active Family Chiropractic Center LLC
- Jessica A. Bowman, LCSW
- Chiroplus Complimentary Health Care Center LLC
- Community Medical Center of Green Lake, LLC (CHN Medical Center Green Lake)
- Community Options, Inc.
- County of Green Lake (Green Lake County DHHS)
- County of Green Lake (Green Lake County DHHS)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.